Temporal variation of chronic child malnutrition in the context of strengthening healthcare services in Burkina Faso: an Oaxaca-Blinder multivariate decomposition analysis.

Malnutrition seriously affects children's health, survival, and future productivity. According to the literature, increasing the supply of health services should help reduce the spread of malnutrition. This article analyses the sources of changes in the decline of chronic malnutrition during the 2000s, where there was an increase in the supply of health services in Burkina Faso. We used data from demographic and health surveys conducted in 2003 and 2010 in Burkina Faso. Malnutrition was defined according to the recommendations of the World Health Organization, while using standards of growth which are current and uniform for the two periods of study considered. We analyzed the source of temporal variation of chronic malnutrition through the Oaxaca-Blinder multivariate decomposition of the proportion of children suffering from chronic malnutrition. The analyses showed that the relative extent of chronic malnutrition in children decreased significantly, from 43.4% (CI 95%: 42.3-44.4) in 2003 to 34.7% (CI 95%: 33.6-35.9) in 2010. A quarter of this variation is due to a change in characteristics (composition effect), and the remaining 74.74% is due to a difference in coefficients (performance or behavior effect). Improved access to health services played a crucial role in reducing the scale of chronic malnutrition between 2003 and 2010. Other factors, such as educating mothers and urbanization, also contributed significantly. This study shows that improving access to health services is crucial for reducing chronic malnutrition. So, programs tackling child malnutrition must first and foremost ensure that children have access to health services.

Birthweight, gestational age, and early school trajectory.

BACKGROUND: Birthweight and gestational age are important factors of not only newborn health by also child development and can contribute to delayed cognitive abilities. However, no study has analyzed the association of birthweight and gestational age with school trajectory measured simultaneously by school entry, grade repetition, and school dropout. This study aims, first, to analyze the association of birthweight or gestational age with school entry, and second, to explore the relationship between birthweight or gestational age and grade repetition and school dropout among children in Ouagadougou, Burkina Faso. METHODS: This study used longitudinal data from the Ouagadougou Health and Demographic Surveillance System. Our samples consisted of children born between 2008 and 2014 who were at least three years old at the beginning of the 2017-18 school year. Samples included 13,676, 3152, and 3498 children for the analysis of the school entry, grade repetition, and dropout, respectively. A discrete-time survival model was used to examine the relationship between birthweight or gestational age and school entry, grade repetition, and dropout. The association between birthweight or gestational age and age at school entry were assessed using a Poisson regression. RESULTS: The incidence rate of school entry was 18.1 per 100 people-years. The incidence of first repetition and dropout were 12.6 and 5.9, respectively. The probability of school entry decreased by 31% (HR:0.69, 95%CI: 0.56-0.85) and 8% (HR:0.92, 95%CI: 0.85-0.99) for children weighing less than 2000 g and those weighing between 2000 and 2499 g, respectively, compared to those born with a normal weight (weight ≥ 2500 g). The age at school entry of children with a birthweight less than 2000 g and between 2000 and 2499 g was 7% (IRR: 1.07, 95%CI: 1.06-1.08) and 3% (IRR: 1.03, 95%CI: 1.00-1.06) higher than children born at a normal birthweight, respectively. Gestational age was not associated with school entry or age at school entry. Similarly, birthweight and gestational age were not associated with grade repetition or dropout. CONCLUSION: This study shows that low birthweight is negatively associated with school entry and age at school entry in Ouagadougou. Efforts to avoid low birthweights should be part of maternal and prenatal health care because the associated difficulties may be difficult to overcome later in the child's life. Further longitudinal studies are needed to better understand the relationship between development at birth and school trajectory.

Factors associated with childhood chronic malnutrition in West and Central Africa: a scoping review.

Chronic malnutrition is a major public health concern that is the focus of a large body of scientific research. However, there is no synthesis of knowledge about the factors associated with this disease in West and Central Africa, where its prevalence is particularly high. We conducted a systematic search for scientific articles published between January 1st, 2000, and October 15th, 2020, that focus on chronic malnutrition in children in West and Central Africa. We queried CAIRN, PubMed, CINAHL, MEDLINE, Scopus, and Google Scholar databases for this purpose. The search process followed the recommendations of Arksey and O'Malley. Items reported in this review follow the PRISMA-ScR guidelines. Sixty articles involving children from a total of twenty (20) countries, mainly Ghana and Nigeria, were included in the final analysis. The data used were predominantly cross-sectional and were mainly drawn from demographic and health surveys. The analysis revealed that chronic malnutrition in children is associated with sociocultural, economic, and healthcare factors related to the characteristics of children, mothers, households, and communities. The association with children's vulnerability to disease, maternal education, purchasing power, and autonomy need to be further investigated in West and Central Africa. Further analysis using longitudinal data is also needed to better understand the factors associated with chronic malnutrition in West and Central Africa.

"It's the poverty"-Stakeholder perspectives on barriers to secondary education in rural Burkina Faso.

Universal primary and secondary education is a key target of the Sustainable Development Goals. While substantial gains have been made at the primary school level, progress towards universal secondary education has slowed, particularly in sub-Saharan Africa. In this study, we aimed to determine perceived barriers of secondary schooling in rural Burkina Faso, where secondary school completion is among the lowest globally (<10%). We conducted a two-stage qualitative study using semi-structured interviews (N = 49). In the first stage, we sampled enrolled students (n = 10), out-of-school adolescents (n = 9), parents of enrolled students (n = 5), parents of out-of-school adolescents (n = 5) and teachers (n = 10) from a random sample of five secondary schools. In a second stage, we interviewed key informants knowledgeable of the school context using snowball sampling (n = 10). Systematic analysis of the pooled sample was based on a reading of interview transcripts and coding of the narratives in NVivo12 using the diathesis-stress model. Recurring themes were classified using a priori developed categories of hypothesized barriers to secondary schooling. Major reported barriers included school-related expenses and the lack of school infrastructure and resources. Insufficient and heterogeneous French language skills (the official language of instruction in Burkina Faso) were seen as a major barrier to secondary schooling. Forced marriages, adolescent pregnancies, and the low perceived economic benefits of investing in secondary schooling were reported as key barriers among young women. Our results guide future interventions and policy aimed at achieving universal secondary education and gender equity in the region.

Stunting, age at school entry and academic performance in developing countries: A systematic review and meta-analysis.

AIM: To review evidence of the effects of stunting, or height-for-age, on schooling level and schooling trajectories, defined as the combination of school entry age, grade repetition and dropouts. METHODS: We conducted a systematic review of studies (last update 20 March 2021) that assessed the association between stunting, or height-for-age, and at least one component of school trajectory using five databases (PubMed, Embase, Education Resources Information Center [ERIC], Web of Science and PsycINFO). Two independent reviewers performed study selection and data extraction. Pooled effects were calculated using the generic inverse variance weighting random-effect model. The risk of bias was assessed using the ROBINS-I tool (PROSPERO ID: CRD42020198346). RESULTS: We screened 3944 articles, and 16 were eligible for the qualitative and quantitative syntheses. Meta-analysis showed that an increase in height-for-age leads to an increase in early enrolment [OR = 1.34 (95% CI, 1.07-1.67)], a reduction in late enrolment [OR = 0.63 (95% CI, 0.51-0.78)], an increase in schooling level [MD = 0.24 (95% CI, 0.14-0.34)] and a reduction in school overage [OR = 0.79 (95% CI, 0.70-0.90)]. Stunted children were more likely to repeat a grade than non-stunted [OR = 1.59 (95% CI, 1.18-2.14)]. CONCLUSION: This review suggests that stunting in childhood might negatively affect school trajectories. Future research should evaluate the effect of stunting on school trajectories and the modification effect of socioeconomic status.

Does sex composition of offspring relate to fertility in urban areas? The case of Ouagadougou, Burkina Faso.

With the onset of the demographic transition in sub-Saharan Africa, couples' desired number of children and the sex composition of offspring may become conflicted, with potential effects on future fertility. While intuitively expected, this effect has not been observed in studies in sub-Saharan Africa, where the level of fertility is higher than in other African regions. In this study, the hypothesis of a conflicted situation was examined by assessing the effect of sex composition of offspring on women's intentions regarding additional children and their use of modern contraceptives. A mixed-method analysis was performed using quantitative data regarding 2567 women aged 35-49 years drawn from a 2012 Demtrend retrospective longitudinal population survey, supplemented by qualitative data collected through 23 in-depth interviews of men and women in Ouagadougou. Results showed that the absence of one sex (boy or girl) in the existing offspring was associated with additional demand for children and lower contraceptive use. These results suggest that a desire for a combination of both girls and boys may be the driving factor contributing to larger family size; that is, continued fertility may not be determined by son preference, but rather by overall composition of offspring, when existing children are all girls or all boys. This could explain the stalling of the fertility decline observed in recent years in Ouagadougou.

Fertility Limitation and Child Schooling in Ouagadougou: Selective Fertility or Resource Dilution?

Using original data collected in Ouagadougou, Burkina Faso, this study investigates evidence for the competing theories that fertility reductions increase children's education through either the quantity-quality tradeoff (intentionally choosing smaller families to make greater investments in education and other indicators of child quality) or resource dilution (having more children reduces resources available per child, regardless of intentionality of family size). The results provide evidence for both hypotheses: children having four or fewer siblings were significantly more likely to be enrolled in school if their mothers had intentionally stopped childbearing relative to those whose mothers wanted more children but whose childbearing was limited by subfecundity. The difference between intentional and unintentional family limitation was not significant for parities greater than five. In addition, the relationship between number of siblings and their schooling is negative, regardless of the intentionality of family-size limitation, but the strength of this negative relationship is approximately twice as high among children whose mothers intentionally limited fertility (reflecting both selection and dilution effects) than among children whose mothers were subfecund (reflecting the pure dilution effect).

Fertility decline and child schooling in urban settings of Burkina Faso.

As evidenced in Western rich countries, Asia, and Latin America, lower fertility allows couples to invest more in each of their children's schooling. This postulate is the key rationale of family planning policies in sub-Saharan Africa. Yet, most studies on Africa have found no correlation or even a positive relationship between the number of children in a family and their educational attainment. These mixed results are usually explained by African family solidarity and resource transfers that might reduce pressures on household resources occasioned by many births as well as methodological problems that have afflicted much research on the region. Our study aims to assess the impact of family size on children's schooling in Ouagadougou (capital of Burkina Faso), using a better measure of household budget constraints and taking into account the simultaneity of fertility and schooling decisions. In contrast to most prior studies on sub-Saharan Africa, we find a net negative effect of sibship size on the level of schooling achieved by children--one that grows stronger as they progress through the educational system.

Rates of coverage and determinants of complete vaccination of children in rural areas of Burkina Faso (1998-2003).

BACKGROUND: Burkina Faso's immunization program has benefited regularly from national and international support. However, national immunization coverage has been irregular, decreasing from 34.7% in 1993 to 29.3% in 1998, and then increasing to 43.9% in 2003. Undoubtedly, a variety of factors contributed to this pattern. This study aims to identify both individual and systemic factors associated with complete vaccination in 1998 and 2003 and relate them to variations in national and international policies and strategies on vaccination of rural Burkinabé children aged 12-23 months. METHODS: Data from the 1998 and 2003 Demographic and Health Surveys and the Ministry of Health's 1997 and 2002 Statistical Yearbooks, as well as individual interviews with central and regional decision-makers and with field workers in Burkina's healthcare system, were used to carry out a multilevel study that included 805 children in 1998 and 1,360 children in 2003, aged 12-23 months, spread over 44 and 48 rural health districts respectively. RESULTS: In rural areas, complete vaccination coverage went from 25.9% in 1998 to 41.2% in 2003. District resources had no significant effect on coverage and the impact of education declined over time. The factors that continued to have the greatest impact on coverage rates were poverty, with its various dimensions, and the utilization of other healthcare services. However, these factors do not explain the persistent differences in complete vaccination between districts. In 2003, despite a trend toward district homogenization, differences between health districts still accounted for a 7.4% variance in complete vaccination. CONCLUSION: Complete vaccination coverage of children is improving in a context of worsening poverty. Education no longer represents an advantage in relation to vaccination. Continuity from prenatal care to institutional delivery creates a loyalty to healthcare services and is the most significant and stable explanatory factor associated with complete vaccination of children. Healthcare service utilization is the result of a dynamic process of interaction between communities and the healthcare system; understanding this process is the key to understanding better the factors underlying the complete vaccination of children.

[Individual and environmental characteristics associated with immunization of children in rural areas in Burkina Faso: a multi-level analysis]. / Les facteurs individuels et du milieu de vie associés à la vaccination complète des enfants en milieu rural au Burkina Faso: une approche multiniveau.

PROBLEM: National and international efforts to immunize children aim to remove barriers that hinder full vaccination programs and to reinforce factors promoting it. Despite Burkina Faso's participation in all international and sub-regional initiatives to protect mothers and children from vaccination-preventable communicable diseases, vaccination coverage there remains low and has grown irregularly, from 34.7% in 1993 to 29.3% in 1998 and 43.9% in 2003. The situation is even more critical in rural than in urban areas. OBJECTIVE: To analyze the contribution of individual and environmental characteristics associated with vaccination of children aged 12-23 months in rural areas in Burkina Faso. Study population and methods. Data from the 1998 DHS (Demographic and Health Survey) and the 1997 Health Ministry Statistical Yearbook were used with a multi-level approach. Analysis distinguished two levels corresponding to the data's hierarchical structure: characteristics of children and their family's environment (level 1) and the health system and social environment (level 2). The study included 805 children aged 12 to 23 months, living in 44 health districts. The dependent variable was the child's vaccination status and is dichotomous (completely vaccinated or not). Completely vaccinated children are those who have received the BCG, the three doses of DTCoq, oral polio, measles and yellow fever vaccines, according to either their vaccination cards or their mothers' statement. RESULTS: The likelihood of vaccination increased with the level of household wealth (OR [well-off/poor]=1.88; [CI: 1.15-3.06] and was strongly associated with use of health services (OR [Prenatal care and assisted delivery/none of these services]=5.64; [CI: 3.16-10.05]). Nevertheless, these 2 variables did not alone explain the differences in vaccination observed between districts. More than 37% of the variation for vaccination completeness can be attributed to differences between health districts. Resources appear to play a minor role but a 1% increase in the proportion of educated women in the district increased the odds of complete vaccination by a factor of 1.14 [CI: 1.01-1.27]. Discussion. Despite universal access to free vaccination, children from poor households are less likely to receive all their vaccines than children from well-off households. This is probably due to indirect costs that stem from vaccination; the financial barrier remains one of the most significant factors preventing complete vaccination. Previous utilization of prenatal care and institutional delivery is more related to dynamics or even interaction between individuals and the health system. In addition to their direct effects, the interrelation between population and health systems may constitute a vaccination culture that may play a major role in explaining vaccination completeness. The resources of the health system bear little relation to vaccination. They are necessary but not sufficient for good health services. The organizational dynamic of health teams, the leadership of health district supervisors and staff motivation are key elements in these processes but were not measured in this study. CONCLUSION: Adding resources to vaccination programs is always a challenge for a number of national healthcare systems. It is not, however, the only key to success. The organization of healthcare systems and the contacts and relationships they establish with their populations appear to be determinant. The local vaccination culture that results from this interaction may be a key to explaining the variations observed between the different health districts.